2. FUNCTIONAL DIAGNOSTICS GASTROINTESTINAL What is Biofeedback? q Provides the patient immediate Auditory and/or Visual information about Physiological Process q It's a Therapy, i.e. type of treatment where people are trained to improve their health by using Signals from their own bodies q By watching the monitor and listening to the sound the patient gets the Feedback information and can adjust thinking and behavior. Improve q The Goal in Lower GI is to Improve Pelvic Floor Dysfunction by teaching patients to change physiologic responses

3. FUNCTIONAL DIAGNOSTICS GASTROINTESTINAL Biofeedback in Lower GI Sphincter EMG Abdominal Pressure q Voluntary Sphincter contractions are recorded. Abdominal pressure as well q Feedback sent to patient (display and/or sound) q Patient actions: To increase sphincter contraction To decrease abdominal pressure Motor Internal Sphincter S2 S3 S4 External Sphincter Efferent

4. FUNCTIONAL DIAGNOSTICS GASTROINTESTINAL Pelvic Floor Training EMG + Pressure EMG Ura Vag Anal Pabd 5" 7"4"18" Duration Increased Effort Straining EMG curve area = Effort Index

5. FUNCTIONAL DIAGNOSTICS GASTROINTESTINAL Patient Selection Process q Evaluate patient - diagnostic tests: AFT/ others q Diagnose patient Incontinence Constipation Others q Evaluate whether this patient would benefit from Biofeedback

6. FUNCTIONAL DIAGNOSTICS GASTROINTESTINAL Pathologies Incontinence Stress Fecal Incontinence due to: q Weak external Sphincter q Dyssynergia IS/ES to Rectum q Pelvic Floor Muscles Dysfunction Constipation q Due to Anismus Non-Neurogenic Origin

7. FUNCTIONAL DIAGNOSTICS GASTROINTESTINAL Biofeedback Process q Perform first biofeedback training in clinic q Help patient train at home q Perform biofeedback assessment in clinic to evaluate progress Change difficulty level q More home training q Etc...

8. FUNCTIONAL DIAGNOSTICS GASTROINTESTINAL Sprite moves up/ down according to patient activity Lane moves right to left Patient tries to follow the lane Lane Sprite Polygraf ID ® Concept

9. FUNCTIONAL DIAGNOSTICS GASTROINTESTINAL Protocol Settings q Primary (and secondary) channel q Capture display rate Lane (Squeeze, Relax) Initial wait Time response Duration Target level Tolerance Number of repetitions Graphics for lane, above lane, below lane and sprite (BMP files) Sound (wave file) Amplitude Time Squeeze Time response

10. FUNCTIONAL DIAGNOSTICS GASTROINTESTINAL Running Biofeedback q Run non-saving mode Monitoring/ Set-up phase Change of protocol must be done before you enter saving mode q Run saving mode 1 or more recordings (training paradigms)

11. FUNCTIONAL DIAGNOSTICS GASTROINTESTINAL Reviewing Biofeedback q Review Lane displayed Hidden markers - bar Calculations (mouse over) q Report Protocol used Fulfillment in percent (percentage time within lane) Relax, squeeze, total

12. FUNCTIONAL DIAGNOSTICS GASTROINTESTINAL Polygraf ID With Polygraf ID ® q Various background screens are available q Curves analysis to quantify training and improvement

13. FUNCTIONAL DIAGNOSTICS GASTROINTESTINAL Pelvic Floor Training EMG + Pressure Anal Sphincter and Abdominal Pressure activity Contract or relax Sphincters AbdominalWallRelaxed ! I try to Contract or relax my Sphincters and keep my Abdominal Wall Relaxed !

14. FUNCTIONAL DIAGNOSTICS GASTROINTESTINAL Pelvic Floor Training Two EMG Sphincter or Vaginal EMG and Suprapubic EMG

15. FUNCTIONAL DIAGNOSTICS GASTROINTESTINAL Accessories Pressure Measurement 1. DPT Pressure Transducer With extension line & flushing syringe 2. Abdominal Catheter a. Opened-end - F8 b. Balloon 1 2a 2b 9021P1091 9021P4221 1. Disposable Surface 3. Reusable Anal Plug With Abdominal catheter insertion lumen 2. Disposable Anal and Vaginal Sponge 1 2 3 EMG Electrodes 9013K0782 9013K0792 9013L4811 9021L0203 9021S0231 9013S0221

16. FUNCTIONAL DIAGNOSTICS GASTROINTESTINAL Polygram Net Biofeedback Application Enhancement wishes with the migration: q A count-down window showing performed/to go procedures (in capture) q Fine tuning of the track directly from the education view - by moving the lane/track to the patients performance level q Progress report that evaluate the patients improvements over time.

17. FUNCTIONAL DIAGNOSTICS GASTROINTESTINAL FUNCTIONAL DIAGNOSTICS Thanks!